Differential post-prostatectomy cancer-specific survival of occult T3 vs. clinical T3 prostate cancer: Implications for managing patients upstaged on prostate magnetic resonance imaging

Muralidhar, Vinayak; Dinh, Kathryn; Mahal, Brandon A.; Ziehr, David R.; Chen, Yu-Wei; Viswanathan, Vidya; Nezolosky, Michelle D.; Choueiri, Toni K.; Hoffman, Karen E.; Hu, Jim C.; Sweeney, Christopher J.; Trinh, Quoc Dien; Nguyen, Paul L.

doi:10.1016/j.urolonc.2015.03.010

Cited by 13 publications

(8 citation statements)

References 35 publications

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“…According to our findings, MFS was significantly shorter in patients with upgrading and upstaging, while grade and stage increase after RP did not reveal any impact on OS, but was associated with inferior ten-year CSS results: 89% vs. 98% for upgrading, and 87% vs. 98% for upstaging. Our findings are consistent with other investigators, where inferior CSS results have been reported for patients undergoing upstaging [23] and upgrading to more aggressive (pISUP ≥ 4) disease [24].…”

Section: Discussionsupporting

confidence: 93%

The Impact of Prostate Cancer Upgrading and Upstaging on Biochemical Recurrence and Cancer-Specific Survival

et al. 2020

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Background and Objectives: Significant numbers of prostate cancer (PCa) patients experience tumour upgrading and upstaging between prostate biopsy and radical prostatectomy (RP) specimens. The aim of our study was to investigate the role of grade and stage increase on surgical and oncological outcomes. Materials and Methods: Upgrading and upstaging rates were analysed in 676 treatment-naïve PCa patients who underwent RP with subsequent follow-up. Positive surgical margin (PSM), biochemical recurrence (BCR), metastasis-free survival (MFS), overall (OS) and cancer specific survival (CSS) were analysed according to upgrading and upstaging. Results: Upgrading was observed in 29% and upstaging in 22% of PCa patients. Patients undergoing upgrading or upstaging were 1.5 times more likely to have a PSM on RP pathology. Both upgrading and upstaging were associated with increased risk for BCR: 1.8 and 2.1 times, respectively. Mean time to BCR after RP was 2.1 years in upgraded cases and 2.7 years in patients with no upgrading (p < 0.001), while mean time to BCR was 1.9 years in upstaged and 2.8 years in non-upstaged cases (p < 0.001). Grade and stage increase after RP were associated with inferior MFS rates and ten-year CSS: 89% vs. 98% for upgrading (p = 0.039) and 87% vs. 98% for upstaging (p = 0.008). Conclusions: Currently used risk stratification models are associated with substantial misdiagnosis. Pathological upgrading and upstaging have been associated with inferior surgical results, substantial higher risk of BCR and inferior rates of important oncological outcomes, which should be considered when counselling PCa patients at the time of diagnosis or after definitive therapy.

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Section: Discussionsupporting

confidence: 93%

The Impact of Prostate Cancer Upgrading and Upstaging on Biochemical Recurrence and Cancer-Specific Survival

et al. 2020

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“…In a recent study, similar BCR rates were seen amongst AS candidates who were pathologically upgraded from Gleason 3+3 to 3+4 . Meanwhile, Muralidhar et al reported that patients with occult T3 disease exhibit better CSS than patients with clinical T3 disease. However, we believe our present study is the first to analyse BCR, metastasis‐free and survival rates from the viewpoint of both adverse pathological features, stratified by D'Amico clinical risk and from the viewpoint of pathological upstaging from clinical D'Amico low‐risk disease.…”

Section: Discussionmentioning

confidence: 70%

Effects of pathological upstaging or upgrading on metastasis and cancer‐specific mortality in men with clinical low‐risk prostate cancer

et al. 2018

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“…Alone, mpMRI has been shown to outperform the Partin tables in the detection of ECE and prediction of organ-confined disease [14] , [15] . Moreover, patients with clinical T3 disease on MRI have twice the risk of prostate cancer-specific mortality (PCSM) versus those with clinical T1/T2 and occult pT3 disease upstaged on final pathology [16] . Unfortunately, reported sensitivity and specificity of mpMRI in the detection of ECE is variable.…”

Section: Introductionmentioning

confidence: 99%

Multi-parametric MRI of the prostate: Factors predicting extracapsular extension at the time of radical prostatectomy

Gaunay

Patel

Shah

et al. 2017

Asian Journal of Urology

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ObjectiveExtracapsular extension (ECE) of prostate cancer is a poor prognostic factor associated with progression, recurrence after treatment, and increased prostate cancer-related mortality. Accurate staging prior to radical prostatectomy is crucial in avoidance of positive margins and when planning nerve-sparing procedures. Multi-parametric magnetic resonance imaging (mpMRI) of the prostate has shown promise in this regard, but is hampered by poor sensitivity. We sought to identify additional clinical variables associated with pathologic ECE and determine our institutional accuracy in the detection of ECE amongst patients who went on to radical prostatectomy.MethodsmpMRI studies performed between the years 2012 and 2014 were cross-referenced with radical prostatectomy specimens. Predictive properties of ECE as well as additional clinical and biochemical variables to identify pathology-proven prostate cancer ECE were analyzed.ResultsThe prevalence of ECE was 32.4%, and the overall accuracy of mpMRI for ECE was 84.1%. Overall mpMRI sensitivity, specificity, positive predictive value, and negative predictive value for detection of ECE were 58.3%, 97.8%, 93.3%, and 81.5%, respectively. Specific mpMRI characteristics predictive of pathologic ECE included primary lesion size ((20.73 ± 9.09) mm, mean ± SD, p < 0.001), T2 PIRADS score (p = 0.009), overall primary lesion score (p < 0.001), overall study suspicion score (p = 0.003), and MRI evidence of seminal vesicle invasion (SVI) (p = 0.001).ConclusionWhile mpMRI is an accurate preoperative assessment tool for the detection of ECE, its overall sensitivity is poor, likely related to the low detection rate of standard protocol MRI for microscopic extraprostatic disease. The additional mpMRI findings described may also be considered in surgical margin planning prior to radical prostatectomy.

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Differential post-prostatectomy cancer-specific survival of occult T3 vs. clinical T3 prostate cancer: Implications for managing patients upstaged on prostate magnetic resonance imaging

Cited by 13 publications

References 35 publications

The Impact of Prostate Cancer Upgrading and Upstaging on Biochemical Recurrence and Cancer-Specific Survival

The Impact of Prostate Cancer Upgrading and Upstaging on Biochemical Recurrence and Cancer-Specific Survival

Effects of pathological upstaging or upgrading on metastasis and cancer‐specific mortality in men with clinical low‐risk prostate cancer

Multi-parametric MRI of the prostate: Factors predicting extracapsular extension at the time of radical prostatectomy

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